子宫动脉血流动力学指标联合PIGF和sFlt-1对妊娠期高血压患者不良妊娠结局的预测价值

Predictive value of uterine artery hemodynamic indexes combined with PLGF and sFlt-1 in adverse pregnancy outcomes in patients with gestational hypertension

目的探讨子宫动脉血流动力学指标联合胎盘生长因子(PLGF)和可溶性血管内皮生长因子受体-1(sFlt-1)在妊娠期高血压疾病(HDPs)患者发生不良妊娠结局中的预测价值。方法选择2020年1月至2021年12月在该院诊断为HDPs的患者106例纳入HDPs组,选择同期该院健康产检者56例纳入对照组。观察HDPs组和对照组子宫动脉搏动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张末期流速比值(S/D)、sFlt-1和PLGF水平变化,观察PI、RI、S/D、sFlt-1和PLGF水平与HDPs严重程度和妊娠结局的关系,以及以上指标预测不良妊娠结局的价值。结果HDPs组PI、RI、S/D和sFlt-1水平明显高于对照组(P<0.01),并且随着HDPs严重程度的升高而升高(P<0.01)。同时,不良妊娠结局者PI、RI、S/D和sFlt-1水平明显高于良好妊娠结局者(P<0.01)。HDPs组血清PLGF水平明显低于对照组(P<0.01),并且随着HDPs严重程度升高而降低(P<0.01),不良妊娠结局者血清PLGF水平明显低于良好妊娠结局者(P<0.01)。PI、RI、S/D、sFlt-1和PLGF预测HDPs患者发生不良妊娠结局具有更高的效能,5项指标联合检测的灵敏度为89.5%,特异度为86.3%,曲线下面积(AUC)为0.940,明显高于sFlt-1(Z=2.690,P<0.01)、PLGF(Z=2.961,P<0.01)和PI+RI+S/D(Z=3.533,P<0.01),而3项指标之间的AUC差异无统计学意义(P>0.05)。结论子宫动脉血流动力学指标、sFlt-1和PLGF水平与HDPs严重程度具有密切关系,子宫动脉血流动力学指标、sFlt-1和PLGF联合检测在预测不良妊娠结局中具有重要的临床价值。

Objective To investigate the predictive value of uterine artery hemodynamic indexes combined with placental growth factor(PLGF)and soluble FMS-like tyrosine kinase-1(sFlt-1)in adverse pregnancy outcome occurrence in hypertensive disorders of pregnancy(HDPs).Methods A total of 106 patients diagnosed as HDPs in this hospital from January 2020 to December 2021 were included as the HDPs group,and contemporaneous 56 subjects undergoing the pregnant physical examination in this hospital were included as the control group.The uterine artery pulsatility index(PI),resistance index(RI),ratio of peak systolic velocity to end-diastolic velocity(S/D),sFlt-1 and PLGF levels were observed in the HDPs group and control group,the relationship between PI,RI,S/D,sFlt-1 and PLGF levels with the HDPs severity and pregnancy outcomes and the value of the above indexes in predicting the adverse pregnancy outcomes in the HDPs group were observed.Results The levels of PI,RI,S/D and sFlt-1 in the HDPs group were significantly higher than those in the control group(P<0.01),in addition which were increased with the HDPs severity increase(P<0.01),moreover the PI,RI,S/D and sFlt-1 levels in the patients with adverse pregnant outcomes were significantly higher than those in the patients with good pregnant outcomes(P<0.01);the serum PLGF level in the HDPs group was significantly lower than that in the control group(P<0.01),moreover which was decreased with the HDPs severity increase(P<0.01),and the serum PLGF level in the patients with poor pregnancy outcome was significantly lower than that in the patients with good pregnancy outcome(P<0.01).PI,RI,S/D,sFlt-1 and PLGF had the higher diagnostic efficiency for predicting the adverse pregnancy outcomes occurrence in HDPs.The sensitivity of the 5-item combined detection was 89.5%,the specificity was 86.3%,and the area under the curve(AUC)was 0.940,which was significantly higher than that of sFlt-1(Z=2.690,P<0.01),PLGF(Z=2.961,P<0.01)and PI+RI+S/D(Z=3.533,P<0.01),while there was no statistically significant difference in AUC among the three indexes(P>0.05).Conclusion The uterine arterial hemodynamic indexes combined with sFlt-1 and PLGF detection has the important clinical value in predicting adverse pregnancy outcomes.